• ABOUT VASECTOMY

    WHAT, HOW, WHY & RISKS

    contraception & vasectomy

WHAT IS VASECTOMY?

Let’s start by explaining that semen, or the ejaculate, is the exciting stuff you know about after ejaculation. Semen is made by the prostate gland and seminal vesicle glands under the bladder.

Sperm, on the other hand, are produced by the testicles but contribute only 2% of the volume of semen. The purpose of sperm is to fertilise an egg, whilst semen nourishes and provides a transport medium for the sperm.

There are two Vas Deferens, or tubes, each carrying sperm from the testicles to the ejaculatory ducts under the bladder where the sperm mixes with semen. Vasectomy is a minor surgical procedure that blocks each vas deferens about two thirds of the way from the upper pole of the testicle to the base of the penis. Sperm is therefore prevented from getting into semen, and are absorbed back into the body.

Success is confirmed with a semen test approximately 25 ejaculations and 12-14 week later when the semen is clear of sperm. Sex and ejaculation feel the same but pregnancy is prevented. The chance of a pregnancy ever occurring after a negative post vasectomy test is exceptionally low at 1 in 2,000.

HOW IS VASECTOMY DONE?

There are two vas deferens (tubes), each attached to a testicle.

Vasectomy requires that both tubes are divided and blocked, but first you need to get to them.

Traditional vasectomy accesses the two tubes via a separate scalpel-incision and stitches for each side, whilst the No Scalpel method accesses both tubes through a single small hole in the middle of the scrotum. Most vasectomies these days are No Scalpel Vasectomy performed whilst awake using local anaesthetic.

Which part of the tube is subsequently blocked? Occlusion of the lower end – the end that is attached to the testicle – defines closed vasectomy. Occlusion of the upper end – leaving the lower end left open – describes open vasectomy. Open-ended vasectomy using a titanium clip or suture is becoming the norm. Suture is more technically challenging but obviates the need to leave titanium behind.

The following illustration summarises the methods of vasectomy – read more.

WHY GET A VASECTOMY?

The top ‘six’ reasons why vasectomy is chosen above other forms of contraception are:

  1. Plan your life – now more relevant than ever before with almost half children in their 20s still living with their parents.
  2. Support your partner who has done the hard yard, and says that she is ‘over hormones!’
  3. No Oopsie’s. Vasectomy offers virtually bulletproof protection against unintended pregnancy, allowing you to enjoy worry-free sex.
  4. Set & Forget – with no pill to forget. Snip and let slip – free from hormones and medical devices.
  5. Vasectomy is the cheapest form of contraception over a few years – see the infographic below.
  6. Environmental concerns are cited by a few guys – though rarely a reason on its own.

Ultimately, it’s about setting family size rather than leaving it to chance.

EFFECTIVENESS & COST COMPARISON

Go to the comparison stats below.

HOW SUCCESSFUL IS VASECTOMY?

Men often say to us that they want to ‘tick that box’ to prevent any future pregnancy.

The vas deferens (tube) does rarely re-join (recanalisation). The first three months is the most common time for recanalisation.

You must get a post-vasectomy semen test to get the all-clear.

The failure rate should be under 1%.

The Vasectomist’s rate of vasectomy failure is around 1 in 500 test results.

Late Failure refers to a pregnancy after getting the all clear from the post vasectomy sample. Thankfully, this is rare at less than 1 in 2,000. Vasectomy ‘failure rate’ describes the lifelong risk of pregnancy whereas the failure rate of other methods of contraception are quoted over a 12 month period. Vasectomy is remarkably effective.

Get the post-vasectomy semen test done, and in the unlikely event of a failure then something can be done about it.
The saying ‘A stitch in time saves nine’ has a certain ring to it when you think of traditional vasectomy!

WHAT ARE THE POSSIBLE SIDE EFFECTS?

Vasectomy can, like any medical procedure, have side effects. Risks are minimised by minimally invasive vasectomy, and are unlikely to change your decision to have the procedure.

Bleeding. A little pin-point bleeding from the skin may occur after the procedure which can be stopped by pinching the skin together firmly for 15 minutes. Post-Vasectomy Haematoma describes internal bleeding that is sufficient to lead to scrotal pain and swelling. The Vasectomist’s rate of serious haematoma is less than 1 in 300. Haematoma will eventually go away on its own, although a large haematoma may take several months to resolve.

Reduce strenuous activity after the procedure to reduce the risk of haematoma.

Infection. The Vasectomist’s rate of infection is less than 1 in 300

Pain. The procedure itself is basically painless thanks to the advent of No Scalpel Vasectomy and Anaesthesia using The very finest needle available.

Post Vasectomy Pain. Post Vasectomy Pain (PVP) Syndrome is defined as discomfort occurring three months after the procedure that is sufficient to interfere with quality of life, and occurs in approximately 1-2% of men. However, only a small number of men with PVP will require a further procedure. Approximately 1 in 1000 men who have had a vasectomy require an operation for post-vasectomy pain.

The author explains to all his patients that PVP at three months occurs in around 1% of his patients. Chronic pain after vasectomy is a rare but recognised side effect. Over half of Australian men get vasectomy, yet you’re unlikely to hear about long term PVP from any of your mates who have had it done.

 A small minority of men read very extensively about post-vasectomy pain syndrome prior to their procedure. This is sure to increase anxiety and can make any niggle afterwards seem like impending doom. There is a general correlation between chronic pain and anxiety to the point that the science is overwhelming. The pain is certainly not in the guy’s head. However, excessive anxiety has the potential to excite the pain pathways as well as making any post-operative pain more difficult to live with.
Therefore, men who are excessively anxious about the possibility of PSVP prior to the procedure should re-consider all options. After all, you either accept the small risk or don’t get a vasectomy.
Prostate Cancer

There was some media concern in 2013 that vasectomy may slightly increase the risk of prostate cancer.  The American Association of Urology have provided a reassuring statement in 2014 following a detailed analysis. They state that ‘vasectomy is not a risk factor for prostate cancer or for high-grade prostate cancer. It is not necessary for physicians to routinely discuss prostate cancer in their preoperative counselling of vasectomy patients.’

There is further strong reassurance about vasectomy and prostate cancer in a Urology journal. The article was published in 2016 and is called ‘Vasectomy and prostate cancer risk: a historical synopsis of undulating false causality.’

MYTHS

  • I don’t have time to get a Vasectomy.

    Seriously? Do you have time for a baby? At the very least, ensure good contraception that will last until you and/or your partner no longer require contraception.

  • Vasectomy is painful.

    Expert no scalpel vasectomy with optimal use of local anaesthetic is not a painful experience.

  • I will be bruised and swollen afterwards.

    Your dad may have referred to ‘blue balls’ – now, mostly, a thing of the past.

  • I saw my dog after his vasectomy!

    Good try! Dogs don’t get a vasectomy, they get the lot taken out (castration). The word ‘Sterilisation” includes both vasectomy and castration, which is one reason why vasectomy doctors don’t use the word. Check the history of vasectomy for other reasons including eugenics.

  • Vasectomy reduces sex drive

    Research suggests that sex is enhanced by vasectomy by eliminating the fear of unwanted pregnancy.

  • My testosterone will be affected.

    Testosterone is completely unaffected.

  • My semen will change.

    Semen is the same afterwards in all five senses.

WHY MIGHT A MAN REGRET VASECTOMY?

Around 2% of men who have had a vasectomy seek a reversal within 10 years of the procedure‎.

So let’s put this in perspective – the vast majority of guys who have a vasectomy will not regret it afterwards.

However, some guys are at greater risk of changing their minds later, and the risk factors are:

  • Not fathered any children
  • Age under 30 (particularly 25).
  • Being Single
  • In an unhappy relationship
  • There has been the death of a child.
  • There has been a change in the relationship.
  • The guy is coerced into having a vasectomy.
  • A very short time between pregnancy and getting a vasectomy.

Couples with babies might want to defer a vasectomy until their baby is >6 months of age. The Doctor will gently raise the risk of Sudden Infant Death Syndrome (SIDS) for men with young babies. The risk of SIDS or ‘cot death’ is around 1 in 2000 babies. The time of maximum risk occurs between the age of 2 and 4 months of age.

90% of men who get a vasectomy have fathered biologically, but can a man who has not fathered get a vasectomy? Whilst good for the planet, the decision needs to be right for you in the long run. Men in their 20’s are best having a non-judgmental chat with the vasectomy doctor about their options. The outcome from this consultation may be:

  • Book in for your vasectomy. Guys over 25 years of age may fall into this category.
  • Postpone the procedure for a few months. Six months is a good ‘cooling off period’ that gives you time and space to consider the issues.
  • Hold off vasectomy for the timebeing.
  • Sperm Banking.

The vasectomist approaches vasectomy in young men who have not fathered by balancing:

  • Your ethical right for autonomy in making your own health decisions.
  • The risk that you might change your mind later.

How Does a Vasectomist approach a 24 year man who has not fathered a child? The fact is undeniable that a very significant percentage of younger men without kids will ask for a reversal later, so you will be asked to accept that. A younger man who says that ‘I know I will (100%) never want kids’ isn’t acknowledging that they might change their mind as they get older, whereas the man who says that  ‘I know there is a chance that I may change my mind later, but I still want to get a vasectomy’ is acknowledging uncertainty in life.

Pushing this further, ask 100 middle-aged adults whether a 24 year old male without kids should be able to get a vasectomy, and you’ll probably find 90% would say ‘no’ (more strongly than that), so there comes a point when an age is simply too young. Do not underestimate how brain development, maturity and life does change you as a person – just ask any 40 year old man what they were like when they were 24. That’s a 16 year age difference,  so you might ask a 24 year old man what they were like were were 8 years old – perhaps a little unfair but does make the point.

What’s the worst thing that can happen if you turn up for a vasectomy but are not quite ready for it?  Just come back in a few months to confirm your decision!

CAN VASECTOMY BE REVERSED?

Vasectomy can be reversed but reversal is expensive and may not work.

Please note that The Vasectomist does not perform vasectomy reversals. See your GP for a referral to a urologist who performs vasectomy reversals. Most Australian capital cities have a few urologists who perform reversals with perhaps 2 to 3 who perform most of them.

The success rate of vasectomy reversal ranges from 50% to 90% depending on the length of time that has elapsed since the vasectomy. Reversal is more successful after a Vasectomy performed <5 years ago compared to a vasectomy performed >10 years ago.

The total price for vasectomy reversal in Australia is typically in the order of $10,000 with a medicare rebate of under $1,000. Private health cover can reduce out of pocket expenses by several thousand dollars. The ‘out of pocket’ for a reversal may be as low as $3,000.

SPERM BANKING

Consider a vasectomy when you are certain that you do not wish to father any or any more children.

However, some men consider sperm banking prior to vasectomy as a form of insurance against unknown unknowns.

The costs of sperm banking is approximately $600 for the initial banking, and $500 per year for freezing.

A referral from your GP may help to reduce the costs of the service.

Men rarely want to pay thousands of dollars over a 10 year period banking their sperm ‘just in case.’ What risk are you prepared to accept? What price would you pay for certainty? Younger men who have not fathered should consider putting off the vasectomy. However, a young man who is determined to get a vasectomy should certainly consider sperm banking because the risk of regret is so high.

Tests prior to sperm banking will generally include a semen analysis and blood tests. The precise blood tests required vary between providers, and include:

  • HIV
  • Hepatitis B&C
  • Syphilis

Contraception: The Stats

Female Contraception Overview
Risk of Pregnancy PER YEARMain BenefitsMain RisksIssues
Combined Pill7% per year (normal use)Low Failure Rate, can reduce period bleeding, can have cycles back-to-back. Often Beneficial for conditions like acne or hirsutism.Deep Vein Thrombosis & Cardiovascular Risk Factors to evaluate include Body mass index, Smoking, Migraine with aura, Family history, increasing age, high BP, Cholesterol, Diabetes, kidney disease etc.Can forget to take the pill.
Progestogen Only Pill9% per year (normal use)Used as a 2nd line oral contraceptive when the combined pill is not recommended. No increased cardiovascular or thrombotic risks.Australian licensed mini pills need to be taken in a 3 hour window each day.The minipill is unforgiving when forgotten – failure rates are high.
Progestogen Injection6% per yearNo increased cardiovascular or thrombotic risks. Periods often disappear completely within 12 months.Progestogenic side effects are usually manageable but women may sometimes report weight gain, mood or changes. Periods often erratic to start with.3 monthly visits to your doctor & practice nurse to get the injection. Need a pregnancy test if late for your next injection.
Progestogen Implant (rod)0.05% per yearPeriods often disappear completely within 12 months.Persistent bleeding beyond 6 months in around 15% of women may require the implant to be removed.3 yearly implant in the inner side of the left upper arm.
Intrauterine Device – Mirena0.2% per yearPeriods usually disappear completely within 12 months – often good for heavy or painful periods.Risk of uterine perforation is around 1 in 1000. Rarely infection or migration of the device.5 yearly re-insertion. Few GPs currently provide this service & most women need a referral to a gynaecologist.
Condom, Cap, RingCondom 18% Cap 12%Caps, Diaphgragm & Vaginal Ring.no systemic risks. Higher rate of failure than many other methods of contraception.Suits only a few women and couples – comes down to personal preference & guidance on use from a health practitioner.
Female Sterilisation0.5% riskLow failure rate at around 1 in 200Higher failure rate & risks (surgical + Anaesthetic) than The Snip.Day Case in a hospital.
Vasectomy1 in 3000 lifetime (after test)The lowest failure rate. Men can get involved!Post vasectomy discomfort affects around 1 in 50 guys.The most important thing is to continue contraception until you get the all-clear after the semen analysis.

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Dr Beatty

Last Reviewed / Modified: 21/6/2021

First Published: 2/8/2019